NPI 1205891256

Jose Alfredo Nicola, IDC

Practitioner Independent Duty Corpsman Great Lakes, IL

Practice location

Address: Naval Health Clininc Great Lakes Branch Medical Clinic 1007 Uss Tranquility, Great Lakes, IL 60088
Phone: (847) 688-2522
Mailing address: 907 Buccaneer Dr APT a, Glenview, IL 60026-7047

Registered specialties

Independent Duty Corpsman Primary

Other Service Providers Taxonomy 1710I1002X

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Registry record

NPI: 1205891256
Entity type: Individual
Sex (as registered): Male
NPI issued: 20 Apr 2006
Record last updated: 18 Apr 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.